Application

Worthington Estate Planning Council
Membership Application

Complete this application and submit it.  You will be redirected to Paypal for payment of dues.

There is no charge for members or substitutes from the same office to attend our regularly scheduled monthly breakfast meetings, but there is a $15.00 fee for guests payable at the time of the breakfast; a $15.00 fee is charged for members or guests with reservations who are “no-shows”.

First, MI, Last Name (required):
First Name (Name tag):
Organization:
Website:
Category:
Other (if selected):
Mailing Address:
City, State:
,
Zip:
Phone:
Email:


Signature:
(PLEASE TYPE YOUR NAME AS SIGNATURE)


Date:    
In order to confirm your membership application, please select the preferred method of payment of the membership fee $140. This includes your regular membership fee ($140) through May 31 of current fiscal year.


Pay with Credit Card via Paypal.
Paypal account is not required.

Will Send a Check for Membership Fee.